Clinical Prediction Models: A Practical Approach to Development, Validation and Updating
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TL;DR: The propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects, and different causal average treatment effects and their relationship with propensity score analyses are described.
Abstract: The propensity score is the probability of treatment assignment conditional on observed baseline characteristics. The propensity score allows one to design and analyze an observational (nonrandomized) study so that it mimics some of the particular characteristics of a randomized controlled trial. In particular, the propensity score is a balancing score: conditional on the propensity score, the distribution of observed baseline covariates will be similar between treated and untreated subjects. I describe 4 different propensity score methods: matching on the propensity score, stratification on the propensity score, inverse probability of treatment weighting using the propensity score, and covariate adjustment using the propensity score. I describe balance diagnostics for examining whether the propensity score model has been adequately specified. Furthermore, I discuss differences between regression-based methods and propensity score-based methods for the analysis of observational data. I describe different causal average treatment effects and their relationship with propensity score analyses.
7,895 citations
Cites background from "Clinical Prediction Models: A Pract..."
...Regression adjustment results in increased precision for continuous outcomes and increased statistical power for continuous, binary, and time-to-event outcomes (Steyerberg, 2009)....
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Book•
17 May 2013
TL;DR: This research presents a novel and scalable approach called “Smartfitting” that automates the very labor-intensive and therefore time-heavy and therefore expensive and expensive process of designing and implementing statistical models for regression models.
Abstract: General Strategies.- Regression Models.- Classification Models.- Other Considerations.- Appendix.- References.- Indices.
3,672 citations
Cites methods from "Clinical Prediction Models: A Pract..."
...Over-fitting has been discussed in the fields of forecasting (Clark 2004), medical research (Simon et al. 2003; Steyerberg 2010), chemometrics (Gowen et al....
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TL;DR: It is suggested that reporting discrimination and calibration will always be important for a prediction model and decision-analytic measures should be reported if the predictive model is to be used for clinical decisions.
Abstract: The performance of prediction models can be assessed using a variety of methods and metrics. Traditional measures for binary and survival outcomes include the Brier score to indicate overall model performance, the concordance (or c) statistic for discriminative ability (or area under the receiver operating characteristic [ROC] curve), and goodness-of-fit statistics for calibration.Several new measures have recently been proposed that can be seen as refinements of discrimination measures, including variants of the c statistic for survival, reclassification tables, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Moreover, decision-analytic measures have been proposed, including decision curves to plot the net benefit achieved by making decisions based on model predictions.We aimed to define the role of these relatively novel approaches in the evaluation of the performance of prediction models. For illustration, we present a case study of predicting the presence of residual tumor versus benign tissue in patients with testicular cancer (n = 544 for model development, n = 273 for external validation).We suggest that reporting discrimination and calibration will always be important for a prediction model. Decision-analytic measures should be reported if the predictive model is to be used for clinical decisions. Other measures of performance may be warranted in specific applications, such as reclassification metrics to gain insight into the value of adding a novel predictor to an established model.
3,473 citations
Cites background or methods from "Clinical Prediction Models: A Pract..."
...Various epidemiologic and statistical issues need to be considered in a modeling strategy for empirical data.(1,19,20) When a model is developed, it is obvious that we want some quantification of its performance, such that we can judge whether the model is adequate for its purpose, or better than an existing model....
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...Validation Graphs as Summary Tools We can extend the calibration graph to a validation graph.(20) The distribution of predictions in those with and without the outcome is plotted at the bottom of the graph, capturing information on discrimination, similar to what is shown in a box plot....
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TL;DR: In virtually all medical domains, diagnostic and prognostic multivariable prediction models are being developed, validated, updated, and implemented with the aim to assist doctors and individuals in estimating probabilities and potentially influence their decision making.
Abstract: The TRIPOD (Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis) Statement includes a 22-item checklist, which aims to improve the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. This explanation and elaboration document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. Each checklist item of the TRIPOD Statement is explained in detail and accompanied by published examples of good reporting. The document also provides a valuable reference of issues to consider when designing, conducting, and analyzing prediction model studies. To aid the editorial process and help peer reviewers and, ultimately, readers and systematic reviewers of prediction model studies, it is recommended that authors include a completed checklist in their submission. The TRIPOD checklist can also be downloaded from www.tripod-statement.org.
2,982 citations
TL;DR: The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used, and is best used in conjunction with the TRIPod explanation and elaboration document.
Abstract: Prediction models are developed to aid health-care providers in estimating the probability or risk that a specific disease or condition is present (diagnostic models) or that a specific event will occur in the future (prognostic models), to inform their decision making. However, the overwhelming evidence shows that the quality of reporting of prediction model studies is poor. Only with full and clear reporting of information on all aspects of a prediction model can risk of bias and potential usefulness of prediction models be adequately assessed. The Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) Initiative developed a set of recommendations for the reporting of studies developing, validating, or updating a prediction model, whether for diagnostic or prognostic purposes. This article describes how the TRIPOD Statement was developed. An extensive list of items based on a review of the literature was created, which was reduced after a Web-based survey and revised during a 3-day meeting in June 2011 with methodologists, health-care professionals, and journal editors. The list was refined during several meetings of the steering group and in e-mail discussions with the wider group of TRIPOD contributors. The resulting TRIPOD Statement is a checklist of 22 items, deemed essential for transparent reporting of a prediction model study. The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study regardless of the study methods used. The TRIPOD Statement is best used in conjunction with the TRIPOD explanation and elaboration document. To aid the editorial process and readers of prediction model studies, it is recommended that authors include a completed checklist in their submission (also available at www.tripod-statement.org).
1,973 citations
Cites background from "Clinical Prediction Models: A Pract..."
...In the prognostic setting, predictions can be used for planning lifestyle or therapeutic decisions based on the risk for developing a particular outcome or state of health within a specific period (1, 2)....
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...Prediction models (also commonly called “prognostic models,” “risk scores,” or “prediction rules” [6]) are tools that combine multiple predictors by assigning relative weights to each predictor to obtain a risk or probability (1, 2)....
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...Internal validation is a necessary part of model development (2)....
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